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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1632912



Case Details

VAERS ID: 1632912 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-28
Onset:2021-06-04
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Death, Dyspnoea, Echocardiogram, Electrocardiogram, Laboratory test, Pulmonary embolism, X-ray
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 81
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Positive for COVID 11/2021 with minimal symptoms
Preexisting Conditions: hypofibrinoginemia, HTN, Breat Cancer; HTN, Kidney disease, hypothyroidism, COPD, sleep apnea
Allergies: cephalexin, ciprofloxacin, levofloxacin, meperidine
Diagnostic Lab Data: CT, XRAY, ECHO, EKG; Multiple labs
CDC Split Type:

Write-up: Patient started having SOB in June 2021; in July found to have a large Pulmonary embolism; Was readmitting for SOB 2 more times and ultimately died 08/24/2021;


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1632912

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